Singapore Medical Association (SMA) president Chin Jing Jih has called for changes in the law on medical liability to protect doctors against excessive patient claims and to prevent defensive healthcare practices that are not good for patients.
His article in the March SMA News comes in the wake of changes this month to the way obstetricians are protected by the Medical Protection Society (MPS), which covers about 10,000 doctors here.
While other doctors are protected for incidents that happened while they were members of the MPS, obstetricians are now covered only for incidents reported while they were members.
This means that if a patient reports an incident years after it happened, an obstetrician would not be covered unless he or she is still an MPS member.
To remain protected when they retire, they need to continue to buy coverage in five-year blocks - currently set at no more than $63,000 or 175 per cent the maximum annual subscription. But MPS still has the right to refuse doctors this extension.
Associate Professor Chin argued that this "indemnity crisis" is not a problem just for the profession but society as a whole.
Painting possible scenarios that would result in "a serious setback" for Singapore's attempts at improving birth rates, Prof Chin said: "Society may have no choice but to regress to less costly options like nurses and midwives.
"In complicated pregnancies, the lack of specialist medical management can potentially result in higher risks to mother and foetus.
"Some citizens may even find the obstetric care costs so prohibitive that they decide to not have any children altogether.
"In the worst-case situation, if obstetric practice is unable to obtain insurance cover, many will likely stop practice."
He added: "Many doctors from other specialties wondered if they would be next in line for the axe."
To prevent such problems, Prof Chin suggests that Singapore follows what Australia did in 2002 after thousands of its doctors were left without coverage when their insurer went bankrupt - possibly triggered by an A$11 million (S$11.4 million) settlement with a woman who needed care her whole life due to birth-induced cerebral palsy.
Aside from bailing out the insurance company, Australia changed some of its laws, such as capping the damages a patient can claim, accepting as defence that a doctor had taken "reasonable care" and holding lawyers personally liable for the costs should they instigate "unmeritorious" claims.
Prof Chin believes that neonatology - which deals with the medical needs of newborn infants and high-risk paediatric neurosurgery - could be next hit. He said: "It would be fair and logical to expect
the same changes to soon affect other specialties that treat or operate on young children."
Responding, Dr Chia Shi Lu, head of the Government Parliamentary Committee for Health, said that Prof Chin's arguments are "valid and probable".
Like Prof Chin, he feared "cherry-picking", with doctors turning down higher-risk patients or practising defensive medicine.
He pointed to some parts of the United States "where there are no practising obstetricians due to the prohibitive cost of malpractice insurance".
Aside from obstetrics, Dr Chia said: "It might also force doctors away from certain high-premium specialties, resulting in an overall drop in the standard of care.
"The rights of patients to seek proper redress should not be compromised, but some balance in the tort system might be needed to address some of the deficiencies in the present system."
This article was first published on April 16, 2015.
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